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The Patient Experience: Living Donor

The Kidney Transplant Center at Crozer-Keystone offers all types of living donor kidney transplant options, from related and unrelated to paired exchange and anonymous, and deceased (or cadaver) kidney transplants.

Living Donor Qualifications

While many people are willing to be living donors, not everyone has the qualities necessary to participate in living donation. Donors must be chosen carefully in order to avoid outcomes that are medically and psychologically unsatisfactory. If your patient has a living donor option or your patient is considering being a living organ donor, it’s important that they educate themselves about the donation process, the required testing, the financial considerations, the risks and the recovery process.

Our Kidney Transplant Patient Guide and our Living Donor Guide provided to transplant candidates and living donor candidates, respectively, presents detailed background, experience and educational information. And of course, the Kidney Transplant Team is always available to answer any questions—from a transplant candidate, from a living donor candidate or from an attending or referring physician.

Informed Consent and the Living Donor Advocate

If your patient decides to become a Living Donor, he/she will be required to read, understand and sign a Living Donor Consent form that confirms his/her understanding of the issues surrounding Living Donation.

As part of this process, your patient will be assigned an Independent Donor Advocate (IDA) who is independent of the transplant patient candidate’s medical team. The Independent Donor Advocate’s role is to help a prospective Living Donor understand the informed consent, evaluation, surgery and follow-up processes and to represent the Living Donor’s interests by advocating for his/her needs, rights, and interests.

Crozer-Keystone’s Living Donor Advocacy Service is made up of skilled professionals who have special knowledge about living donation, transplantation, medical ethics and informed consent. These professionals are not on The Kidney Transplant Program staff and are therefore in a unique position to be more objective about and supportive of the living donor.

Living Donor Advocate’s Responsibilities

The Living Donor Advocate’s responsibilities include making sure that:

Your patient understands what the doctors, nurses and other transplant team members are telling him/her about living donation.

Your patient is well informed about living donation so that if he/she does decide to consent to donate, that he/she does so after careful consideration and with good information.

Your patient is not experiencing any pressure or other inappropriate encouragement to donate.

Your patient can ask any question and get honest and clear answers with complete privacy and confidentiality.

Even though the Living Donor Advocate is not a member of the Kidney Transplant Team, he or she will provide the team with enough information about your case so the team is confident you are under the care of the advocate. Any information shared will be done so in your best interest and according to the patient information privacy laws of the Commonwealth of Pennsylvania.

Donor Candidate Evaluation

Potential living donors first undergo a blood test to determine blood type compatibility with the recipient.If the donor and recipient have compatible blood types, the next step for the donor is a medical history review and a complete physical examination.In the examination, physicians may perform the following tests:

Tissue Typing: To check the tissue match between six codes on the potential living donor and recipient cells. While still required as part of the transplant process, tissue typing is rarely a consideration for living organ donation.

Crossmatching: To see if the potential recipient will react to the potential living donor’s organ. Although each test is an important part of kidney selection, the crossmatch is the most important test. To receive a kidney transplant, the recipient must have a compatible crossmatch with the donor. If the crossmatch is "positive," then the donor and patient are incompatible because antibodies will immediately react against the donor’s cells and consequently cause immediate loss of the transplant. If the crossmatch is "negative," then the transplant may proceed.

Antibody Screen: Because antibodies attack the transplanted organ, the antibody screen tests for panel reactive antibody (PRA). The white blood cells of the potential living donor and the serum of the recipient are mixed to see if there are antibodies in the recipient that react with the antigens of the donor.

Blood tests to screen for transmissible diseases: used to determine if a potential living donor has HIV/AIDS, hepatitis and other transmissible diseases.

X-Rays: A chest X-Ray and an electrocardiogram (EKG): Depending upon the age and medical history of the potential living donor, other heart and lung tests may be needed.

Radiologic testing: Can include a CAT scan, MRI, and arteriogram to view the organ to be donated.

Cancer screening: May include a colonoscopy, mammogram, prostate exam and skin cancer screening, depending upon the age and medical history of the potential living donor.

Psychiatric and/or psychological evaluation: Both the potential living donor and the recipient may undergo a psychiatric and/or psychological evaluation. These tests assess the mental health of the potential living donor, whether the donor feels pressure from others to donate, the donor’s ability to understand information and make an informed decision, and the donor’s daily life circumstances (such as the possible impact on a job, whether he/she would have any help while recovering from donation, and the donor’s family’s views about the donation).

Gynecological examination: For all female donors, a complete gynecological examination is required. For females 32 years and older, a mammogram is also required.

Final blood test: Usually completed within 48 hours of surgery, the last blood test is another crossmatch. It is the final comparison of the potential living donor’s blood cells and recipient's blood serum to make sure that the recipient has not created any antibodies that would attack the donated organ.

All of these test procedures are performed at the Kidney Transplant Center, usually on an outpatient basis, but in some cases, testing may require an overnight hospital stay.

Living Donor Surgery

The surgical removal of the donor kidney in a Living Donor situation can be done by one of two ways: either a Laparoscopic Nephrectomy or an Open Nepherctomy.

Laparoscopic Donor Nephrectomy

Laparoscopic Nephrectomy involves the surgeon making two or three small incisions close to the navel. The kidney is removed through the central incision. Through one of the other openings, a laparoscope is used to produce an inside view of the abdominal cavity and to guide them through the procedure.

In comparison to the standard, Open Nephrectomy operation, Laparoscopic Nephrectomy results in a smaller incision, reduces recuperation time and usually shortens hospital stays. Many donors are discharged from the hospital after two days and return to normal activity within four weeks.

Not all donors can undergo Laparoscopic Nephrectomy. A donor may not qualify for the procedure if:

He/She has had multiple previous abdominal surgeries

He/She is significantly overweight

There is abnormal anatomy of the kidney

The Kidney Transplant Team, in conjunction with you as the primary care provider, will complete an evaluation to determine if laparoscopic donor nephrectomy is a possibility.

Open Nephrectomy

Open Nephrectomy has been the standard for the last 35 years and involves a five to seven inch incision on the side of the chest and upper abdomen. A retractor is usually needed to spread the ribs to gain access to the donor kidney. Sometimes, it's necessary to remove part of a rib for better exposure. The operation typically lasts three hours, and the recovery in the hospital averages four to five days. Donors can usually return to normal activity within four to twelve weeks.

Recovery and Life After Donation

Living Donor recovery is typical for a surgical procedure, and depending upon whether the surgery is a Laparoscopic Nepherctomy or an Open Nephrectomy, donors usually stay in the hospital between a few days and a week after surgery. Although recovery time varies, most kidney donors return to normal activities after four to six weeks, depending on the physical demands of the donor’s daily living and work tasks. Post-surgery, donors may not be able to drive for up to two weeks and may have lifting restrictions for at least six weeks.

Potential Risks For Living Donor

Living donation involves anesthesia and major surgery and their associated risks. As with any major operation, there are risks involved. For example, all patients experience some pain and discomfort after a surgical procedure. Although each situation is different, donors typically have a rapid and uneventful post-operative course. The first twenty-four hours after surgery, the donor is usually sleepy and tired, a natural reaction to surgery and anesthesia.

It is possible for kidney donors to develop infections or bleeding. Other surgical complications can include pain, infection, blood loss (requiring transfusions), blood clots, allergic reactions to anesthesia, pneumonia, injury to surrounding tissue or other organs and even death.

Some possible risks of kidney donation may include high blood pressure (hypertension); large amounts of protein in the urine; hernia; organ impairment or failure that leads to the need for dialysis or transplantation; and even death. There may be other medical risks for organ donation surgery since there are limited data about long-term complications and since each donor’s surgery and recovery experience is unique.

In addition to potential individual health concerns, it is possible for negative psychological consequences to result from living donation. Negative psychological symptoms are possible during the healing process and even years after the donation. For example, depression and anxiety after donation are common concerns and often attributed to the healing process of surgery, renewed family demands and an attention shift from the donor onto the recipient. As a result, patients may have feelings of regret, resentment, or anger.

Please note that there has been no national systematic long-term data collection on the risks associated with living organ donation. Based upon limited information that is currently available, overall risks are considered to be low, but risks can differ among donors.

Research has shown that there's little long-term risk for kidney donation, provided the candidate is carefully screened before becoming a donor. Generally, the long-term survival rate, quality of life, general health status and risk of kidney failure are about the same as that for people in the general population who aren't kidney donors.

Prospective kidney donors receive thorough medical exam (both with the primary care provider and with the Kidney Transplant Center) to determine whether they are a good match for the potential recipient and to make sure that the potential donor does not have health problems that might be made worse by donating a kidney.

Requesting a Consult

The Crozer-Keystone Kidney Transplant Team will work closely with you to co-manage patient care and provide you with support resources and assistance throughout the care continuum.

Consults are always available for both pre- and post-transplant patients, as well as for living donor candidates. To make a referral or to request a consult—or even just to ask a question—call The Kidney Transplant Team at 610-619-8420 or email kidney@crozer.org. You will receive a prompt reply.